Follow-up Of Anterior Sagittal Anorectoplasty For The Treatment Of Congenital Anorectal Malformations Vestibular Fistula

Objective：Congenital anorectal malformation vestibular fistula is the mostcommon type in girls with anorectal malformations. In the past, this type ofmalformation always be thought to have a better outcomes and less associateddeformity. The patients are treated through anterior sagittal anorectoplasty in China.But there was little studies about the follow-up. This is a retrospective study ofanorectal malformation vestibular fistula. The purpose of this study is to know theassociated deformity proportion of the ARMVF, and the bowel function afteroperation.Methods: The patients of ARMVF treated in Beijing Children’s Hospital from2002to2012were collected. Records included the age at surgery, deformity,complications after operation. The follow-up were conducted through telephone orquestionnaire. The bowel functions of the patients were evaluated by Internationalgrouping (Krickenbeck) of surgical procedures for follow-up, anorectal manometryand lower gastrointestinal imaging.Results：The rate of the associated deformity with congenital anorectalmalformation vestibular fistula is50.6%, and the cardiology malformationsproportion is most (33.3%), followed by the spinal deformity (27.8%),genitourinary system (24.1%). Two and above associated malformations accountfor27.1%of patients (22/81). In the evaluation of bowel function,34.1%(22/70)of patients had a voluntary bowel movement, as well as58.6%(41/70) hadconstipation and18.6%(13/70) had incontinence. According to the age of surgery, the patients were divided into4groups. And we found the maybe the age at surgerywere negatively correlated with bowel function by using the statistical method. Theanorectal manometry were done in13patients and the lower gastrointestinalimaging were done in12patients. The average of anal resting pressure was36.97±24.42mmHg, and31.96±22.70mmHg with constipation.50%of patients (6)with constipation whose rectum or sigmoid was widened.3D anorectal manometryresults show that both sides of the coronal common pressure absent bands.Conclusion:1. The rate of the associated deformity with Congenital anorectal malformationvestibular fistula is50.6%. The top three are the cadiology malformations,genitourinary malformations and spinal deformity. Multiple and complexmalformations are not rare.2. Constipation is the most commen problem after the ASARP of the ARMVF. Thesolling is much less. The anal pressure of the patients of the ARMVF is muchlower, while the colorectal in most of them are widened.3. The analysis suggests that the doing surgery in the neonatal period also has agood bowel function and less complication.